{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:02:41Z","timestamp":1790103761858,"version":"4.0.1"},"reference-count":11,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,2]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>A man in his 50s presented with abdominal pain and haemodynamic instability following a fall. CT imaging suggested haemoperitoneum with suspected splenic venous injury and revealed previously undiagnosed cirrhosis with portal hypertension. The patient was admitted and managed conservatively. However, he developed persistent anaemia and hypotension despite repeated blood transfusion. Diagnostic paracentesis performed to evaluate possible spontaneous bacterial peritonitis yielded frank blood. Repeat imaging demonstrated increasing haemoperitoneum within the left upper quadrant. The patient developed haemorrhagic shock and underwent laparotomy, revealing extensive haemoperitoneum and splenic vascular bed bleeding without parenchymal injury. Portal hypertensive bleeding from splenic varices was suspected. Portal decompression with transjugular intrahepatic portosystemic shunt was performed, with haemodynamic improvement and cessation of bleeding upon repeat laparotomy. This case is among the few reported examples of traumatic rupture of ectopic varices, managed with transjugular intrahepatic portosystemic shunt alone, emphasising the importance of early recognition and portal decompression.<\/jats:p>","DOI":"10.1136\/bcr-2026-274156","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:15:28Z","timestamp":1790100928000},"page":"e274156","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Splenic variceal haemoperitoneum mimicking splenic trauma managed by transjugular intrahepatic portosystemic shunt"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-9547","authenticated-orcid":false,"given":"Faris","family":"Gondal","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5469-4317","authenticated-orcid":false,"given":"Joshua Haron","family":"Abasszade","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Department of General Medicine, Northern Hospital Epping, Epping, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeraj","family":"Bhala","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beng Ghee","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Raj","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211151954000_19.9.e274156.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/541836","article-title":"Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension","volume":"2013","author":"Biecker","year":"2013","journal-title":"ISRN Hepatol"},{"key":"2026092211151954000_19.9.e274156.2","doi-asserted-by":"crossref","unstructured":"Dervishi M , Stevens A , Sutter C , et al . Endovascular Management of Bleeding Ectopic Varices. Tech Vasc Interv Radiol 2025;28. doi:10.1016\/j.tvir.2025.101080","DOI":"10.1016\/j.tvir.2025.101080"},{"key":"2026092211151954000_19.9.e274156.3","first-page":"167","article-title":"Ectopic varices","volume":"1","author":"Sarin","year":"2012","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"2026092211151954000_19.9.e274156.4","doi-asserted-by":"crossref","unstructured":"Sincos IR , Mulatti G , Mulatti S , et al . Hemoperitoneum in a cirrhotic patient due to rupture of retroperitoneal varix. 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Cureus 2021;13. doi:10.7759\/cureus.18955","DOI":"10.7759\/cureus.18955"},{"key":"2026092211151954000_19.9.e274156.8","doi-asserted-by":"crossref","first-page":"2978","DOI":"10.1016\/j.radcr.2023.06.011","article-title":"Traumatic omental variceal rupture-treatment with transjugular portosystemic shunt (TIPS) and embolization","volume":"18","author":"Masood","year":"2023","journal-title":"Radiol Case Rep"},{"key":"2026092211151954000_19.9.e274156.9","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1177\/19253621241259827","article-title":"Fatal Hemoperitoneum Secondary to a Spontaneous Splenic Vein Rupture","volume":"14","author":"Fleury","year":"2024","journal-title":"Acad Forensic Pathol"},{"key":"2026092211151954000_19.9.e274156.10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0140-6736(98)06020-6","article-title":"Bacterial infection in the pathogenesis of variceal bleeding","volume":"353","author":"Goulis","year":"1999","journal-title":"The Lancet"},{"key":"2026092211151954000_19.9.e274156.11","doi-asserted-by":"crossref","first-page":"668","DOI":"10.2214\/AJR.13.12211","article-title":"Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices","volume":"203","author":"Deipolyi","year":"2014","journal-title":"AJR Am J Roentgenol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-274156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:15:31Z","timestamp":1790100931000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-274156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":11,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-274156"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-274156","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}